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Gen Med Unit 5 > Prostatitis > Flashcards

Prostatitis Flashcards

1
Q

Define prostatitis

A

Inflammation of the prostate gland

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2
Q

Categories of prostatitis

A

Acute bacterial
Chronic bacterial
Nonbacterial

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3
Q

What is the etiology of acute bacterial prostatitis?

A
  1. Ascending urethral infection
  2. Most common pathogens (Gm-)
    -E. Coli (58-88%)
    -Proteus, Klebsiella, Serratia, Pseudomonas
    STD’s
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4
Q

What is the etiology of chronic bacterial prostatitis?

A
  1. Chronic recurrent sx’s w/prostate bacteria
    - E. coli (75-80%)
    - Enterococci (Proteus, et al),Pseudomonas
    - Chlamydia trachomatis
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5
Q

What is the etiology of chronic non- bacterial prostatitis?

A
  1. Chronic recurrent sx’s w/ no bacteria
  2. Cause unknown
    3.Theories:
    Noninfectious inflammation due to:
    -Pelvic muscle spasm
    -Ejaculatory duct obstruction
    -Autoimmune disorder
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6
Q

What is the most common type of prostatitis?

A

Chronic non bacterial

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7
Q

How do bacteria infect the body?

A

Ascent of infection up urethra and reflux into prostatic ducts

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8
Q

Which category of prostatitis is a diagnosis of exclusion?

A

Nonbacterial prostatitis

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9
Q

What are the sxs of acute bacterial prostatitis?

A
  1. Sudden or rapid progression of sx’s-acutely ill
  2. Fever, chills, malaise, myalgias
  3. Low back pain
  4. Perineal pain
  5. Irritative voiding sx’s:
    - Frequency, -decreased stream, -dribbling, -urgency, -dysuria
  6. Hesitancy
  7. Hematuria
  8. Cloudy urine
  9. Exquisite tenderness of prostate
  10. Enlarged, firm prostate
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10
Q

What are the sxs of chronic bacterial prostatitis?

A
  1. Sometimes asymptomatic
  2. +/- Hx of STD
  3. Recurrent UTI sx’s
  4. Irritative voiding sx’s
  5. +/- Suprapubic pain
  6. +/- Perineal, testical pain
  7. +/- Low back pain
  8. BM Discomfort
  9. Ejaculation pain +/- blood
  10. Prostate may feel normal or boggy
  11. Mildly tender
  12. +/- enlarged prostate
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11
Q

What are the sxs of chronic prostatitis/chronic pelvic pain syndrome?

A
  1. Obstructive sx’s
    -Slow stream, hesitancy, dribbling
  2. Pain:
    Perineum, low abdomen, testicles, penis, with ejaculation +/- blood
  3. Persistent irritative sx’s:
    -Urgency, frequency, nocturia
  4. Nontender or mildly tender prostate
  5. May be enlarged
  6. Firm prostate
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12
Q

What are the results of a U/A in Acute bacterial prostatitis?

A

Pyuria
Bacteriuria
+/- Hematuria: commonly has traces of blood

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13
Q

What are the results of a Ur C&S in Acute bacterial prostatitis?

A

Identifies pathogen

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14
Q

What are the results of a CBC in Acute bacterial prostatitis?

A

Leukocytosis

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15
Q

What are the results of PSA in Acute bacterial prostatitis?

A

Transient increased PSA

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16
Q

What are the results of a U/A in Chronic bacterial prostatitis?

A

Usually normal

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17
Q

What are the results of a prostatic secretion C & S in Chronic bacterial prostatitis?

A

Identifies pathogen
Confirms Dx
Rarely done

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18
Q

What are the DS results in nonbacterial prostatitis?

A

Diagnosis of Exclusion
(-) U/A
(-) UC
Bladder, testicular Sono, CT, etc.

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19
Q

In pt Tx for Acute bacterial prostatitis

A
  1. Hospitalization if septic
  2. IV antibiotics
    A. Ciprofloxacin (Cipro) 400 mg IV q 12h + gentamicin
    5 mg/kg/d
    After pt afebrile for 24-48 hours, change to oral
    Cipro 500 mg bid or Levaquin 500 mg qd x 6 weeks
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20
Q

What catheter is preferred for acute bacterial prostatitis?

A

Urine catheterization is CONTRAINDICATED

Percutaneous catheter is preferred

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21
Q

What is the outpt tx for acute bacterial for men under 35 yrs?

A
  1. Ceftriaxone (Rocephin) 250 mg IM + doxycycline 100 mg bid x 10 d or azithromycin (Zithromax) 1 gm po x 1 d
  2. Ciprofloxacin (Cipro) 500 mg po bid x 4-6 wks
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22
Q

What is the outpt tx for acute bacterial for men over 35 yrs?

A

Ciprofloxacin (Cipro) 500 mg po bid x 10-14 days

Trimethoprim /sulfamethazole (Bactrim) DS po bid x 10-14 days

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23
Q

Tx for Chronic bacterial prostatitis?

A
  1. Ciprofloxacin (Cipro) 500 mg bid x 6 wks or
  2. Trimethoprim /sulfamethazole (Bactrim) DS 1 po bid x 4-12 wks
    or
  3. Azithromax (Zithromax) 500 mg 3x/week x3 wks (Chlamydia)
  4. Anti-inflammatory agents
  5. Hot sitz baths
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24
Q

Tx for nonbacterial protatitis?

A

1.Alpha 14 Blockers + Antibx
Tamsulosin (Flomax) 0.4 mg qd + Ciprofloxacin (Cipro) 500 mg bid x 6 wks
2. NSAIDS
3. Sitz baths

  1. Refer to Urologist if sx’s persist
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25
Q

Define Orchitis

A

Acute inflammatory reaction of the testicle secondary to infection (viral or bacterial)

26
Q

What is the pathophys of mumps orchitis?

A

Most common etiology. Mumps orchitis follows the development of parotitis by 4-7 days
-20-25% of prepubertal patients with mumps develop orchitis

27
Q

What is the pathophys of bacterial orchitis?

A

Bacterial orchitis can be associated with epididymitis or prostatitis

  • Occur in sexually active males older than 15 years or in men older than 50 years w/ BPH
  • Ascending bacterial infection from urinary tract: Chlamydia, gonorrhea
28
Q

What pathogens cause the most common form of acute orchitis?

A

Viral

29
Q

What are common bacterial pathogens for orchitis?

A 
Neisseria gonorrhea
Chlamydia trachomatis
Pseudomonas aeruginosa
E. coli
Klebsiella pneumonia
30
Q

What complications can occur from orchitis?

A

Unilateral testicular atrophy occurs in 60% of patients with orchitis

Drop in sperm count 1 in 10 males

31
Q

What are the symptoms of orchitis?

A
  1. Testicular pain and swelling
    -Mild discomfort to severe pain
  2. Assoc. systemic sx’s:
    Fatigue
    Malaise
    Myalgias
    Fever and chills
    Nausea
32
Q

What are the signs of orchitis?

A
  1. Fever
  2. Testicular swelling & tenderness
  3. Erythematous & edematous scrotal skin
  4. Enlarged epididymis associated with epididymo-orchitis
33
Q

What are the DS: U/A, results in bacterial orchitis?

A

pyuria & bacteriuria, +/- GC, Chlamydia

34
Q

Why is a doppler U/S performed in orchitis?

A

R/O testicular torsion or abscess

35
Q

What is the tx of orchitis?

A
  1. Bed rest
  2. Hot or cold packs for analgesia
  3. Support of the scrotum
  4. Analgesics
  5. Antibiotics for bacterial orchitis
    A.< 35 yr
    Ceftriaxone (Rocephin) 250 mg IM + doxycycline 100 mg bid x 10 d
    B. 35 yr or >
    Ceftriaxone (Rocephin) 250 mg IM + ciprofloxacin (Cipro) 500 mg bid x10d
36
Q

Define acute epididymitis

A

Inflammation of epididymis

37
Q

What is the prevalence of epididymitis?

A

Incidence is less than 1 case in 1,000 males per year

Common ages 19 – 40 years

Most common cause of intrascrotal inflammation

38
Q

What is the route of infection in epididymitis?

A

Urethra  ejaculatory duct  vas deferens  epididymis

39
Q

What is the pathophys of epididymitis?

A
  1. Secondary to trauma
  2. Causative organism is identified in 80% of patients
    - Agent Varies according to the age of the patient
40
Q

What pathogens cause Epididymitis in prepubertal males?

A

E. coli

41
Q

What pathogens cause Epididymitis in sexually active males?

A
  1. Chlamydia trachomatis

2. Neisseria gonnorhea

42
Q

What pathogens cause Epididymitis in elderly males?

A
  1. E. coli

2. Pseudomonas

43
Q

What are the sxs in epididymitis?

A
  1. Swelling & pain of scrotum
    - May radiate up to ipsilateral flank
  2. +/- Irritative voiding sx’s
  3. +/-Urinary retention
    - Bladder outlet obstruction in older patients
  4. +/- Fever and chills
  5. +/- Urethral discharge
  6. Exquisitely tender epididymis
  7. Erythematous edematous scrotum
44
Q

What is the Prehn sign and what is it used for?

A
  1. Prehn sign is a classic sign of epididymititis

2. Not reliable for distinguishing epididymitis from testicular torsion

45
Q

What are the U/A results for epididymitis?

A

Pyuria or bacteriuria (50%)

46
Q

Who should have a Urine C&S performed for epididymitis?

A

Prepubertal and elderly patients

47
Q

What are the urethral gram stain and culture for epididymitis?

A

Gram (-) intracellular diplococci

48
Q

What pathogens do you look for in epididymitis?

A

GC/Chlamydia

Test for syphilis and HIV

49
Q

When is a CBC ordered in epididymitis?

A

If patient appears systemically ill or toxic

Leukocytosis with left shift

50
Q

Why is a doppler ultrasound ordered in epididymitis?

A

R/O testicular torsion

51
Q

What is the tx for epididymitis?

A
  1. Obtain immediate urologic consultation if unable to clearly differentiate testicular torsion from epididymitis or other scrotal pathology
  2. Antibiotic therapy
  3. Analgesics for pain control: generally w/ anti-inflammatory component
  4. Supportive care
    - Scrotal support
    - Ice pack
52
Q

What antibiotics should be used in epididymitis?

A
  1. Ciprofloxacin (Cipro) 500 mg bid x 10d
    or
    Trimethoprim/ sulfamethoxazole Bactrim) DS po bid x 10d
  2. Ceftriaxone 250 mg IM + Doxycycline 100 mg bid x 7d
    Neisseria gonnorhea
    Chlamydia trachomatis
53
Q

Define urethritis

A

Inflammation of urethra

54
Q

What are common pathogens for urethritis?

A
  1. N. gonorrhea
  2. C. trachomatis
  3. Mycoplasma genitalium
  4. Ureaplasma urealyticum
  5. Trichomonas vaginalis
  6. “Nongonococcal”
55
Q

What are the noninfectious causes of urethritis?

A

Reactive arthritis (Reiter Syndrome)

56
Q

What are the sxs of urethritis in men?

A
  1. Irritative void sx’s
  2. Dysuria
  3. Inflamed urethral orifice
  4. Serous or milky urethral discharge
  5. +/- blood-tinged
57
Q

What are the sxs of urethritis in women?

A
  1. Irritative voiding sx’s
  2. Purulent urethral discharge
  3. Urethral orifice erythema
  4. Assoc. w/ vaginitis and cervicitis:
    GC active during menses
58
Q

How is urethritis diagnosed?

A
  1. Urine C&S
  2. Gram stain and Culture
  3. Nucleic acid amplication testing (NAAT):
    A. For N. gonorrhea & C. trachomatis
    -Endocervical swab
    -Vaginal swab
    -Urethral swab (men)
    -Urine (men & women)
    1st urine
59
Q

What complications can arise from urethritis?

A 
1. Disseminated gonococcal disease
A. Septic arthritis
B. Conjunctivitis
-Purulent 
-Can rapidly progress to panophthlamitis and loss of the eye unless prompt tx
60
Q

How is gonococccal urethritis treated?

A
  1. Ceftriaxone 250 mg IM + azithromycin (Zithromax) 1 gm po
    or
    doxycycline 100 mg po bid x 7d

Gen Med Unit 5 (8 decks)

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